[Functional results of pancreatic surgery]

Indications of pancreatectomy for benign diseases and a better knowledge of natural history of chronic pancreatitis need precise evaluation of functional results of pancreatic surgery. Pancreaticoduodenectomy generally results in weight loss when indicated for cancer and weight gain when indicated for chronic pancreatitis. Even when pancreatic parenchyma is normal, pancreaticoduodenectomy usually leads to exocrine insufficiency needing enzyme therapy. The risk of diabetes related to pancreaticoduodenectomy is less than 10%; in case of chronic pancreatitis, the over-risk due to surgery is less than 10% too. Left pancreatectomy does not result in exocrine insufficiency. Conversely, left pancreatectomy can induce diabetes even when pancreatic parenchyma is normal, and especially when pancreatic resection exceeds 75%. When performed for chronic pancreatitis, left pancreatectomy strongly increases the risk of diabetes related to the disease. Total pancreatectomy results in total exocrine insufficiency and diabetes with high risk of hypoglycemia. Limited pancreatectomies (isolated head resection for chronic pancreatitis, medial pancreatectomy, enucleation), rarely indicated, do not result in pancreatic failure. Among by-pass procedures, wirsungo-jejunostomy does not improve exocrine function and could reduce (or at the least delay) the risk of diabetes occurrence related to chronic pancreatitis.